Infectious Endocarditis

Infectious EndocarditisCLINICAL SIGNS:

* fever variable without particularity, elevated with chills in acute forms.

* appearance or aggravation of a heart murmur.

* alteration of the general state, slimming, arthralgia.

* fake osaris parsley painful and fleeting.

* moderate inconstant splenomegaly.

* rarely, erythematous palmoplantar eruption.

* complications:

– acute heart failure with OAP.

– atrioventricular conduction disorders.

– cerebral or coronary septic emboli.

* any unexplained fever> 8 days in a known valve, any appearance or modification of a breath should be considered as an infectious endocarditis.

ETIOLOGY:

* Staphylococcus, streptococcus, Gram-bacillus, yeast infection following:

– dental care .

– skin ulcer, burn, eczema .

– sinusitis, otitis.

– intravenous injection (drug addicts).

– endoscopy, cystoscopy, abortion, colonic surgery, urinary catheterization, …

* contributing factors:

– Valvular prosthesis , valvulopathies

– congenital heart disease, obstructive cardiomyopathy.

DIAGNOSTIC TESTS:

* blood cultures .

* ECBU, NFS, VS, CRP.

* echocardiography as soon as possible: images of vegetation, image of underlying heart disease.

TREATMENT:

* venous route: G5%.

* high dose antibiotic for 15 days:

– first-line: aminoglycoside, 1.5 mg / kg x 2 / d + Penis G, 20-30 M / d IV.

– according to the antibiogram if possible:

 aminoglycosides + Bristopen 8g / d IV if methicillin-sensitive staphylococcus.

 aminoglycosides + C IIIG if gram negative bacillus.

 if allergy to penicillin: Vancomycin: 15 mg / kg x 2 / d.

* in some cases, surgical correction of the valve:

– hot or delayed.

* prevention of subjects at risk: Clamoxyl, 3 g one hour before dental care or an instrumental gesture (Pyostacine: 1 g if allergy to penicillins).

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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